Non-Cochrane · intervention · PM42041668
Lower Third Molar Germectomy: Timings, Indications, and Clinical and Patient-Reported Outcomes-A Systematic Review and Meta-Analysis.
Scilla Francesco, Malvicini Giulia, Parrini Stefano, et al. · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14040215
Findings
Population Pediatric and adolescent patients with developing mandibular third molars
3 findings
| Early mandibular third molar removal (germectomy, immature developmental stage) | Delayed extraction at a more advanced root development stage or older age | Inferior alveolar nerve (IAN) injury Postoperative; follow-up varied by study · University clinics and hospitals (Italy, China, Uzbekistan) · Overall | RR 0.05 [0.01, 0.37] GRADE not reported Downgraded: risk of bias, imprecision 2 studies |
| Early removal (germectomy / immature extraction) | Delayed extraction of fully developed third molars (older age) | Overall postoperative complications (composite) Longest available follow-up · University clinics and hospitals · As plotted in Figure 7 Unresolved: the two extractors disagree on this row. | RR 0.30 [0.21, 0.44] GRADE not reported Downgraded: risk of bias, imprecision, indirectness 3 studies · 2676 participants |
| Early mandibular third molar removal (germectomy, immature developmental stage) | Delayed extraction at a more advanced root development stage or older age | Overall postoperative complications (composite) Postoperative; follow-up varied by study · University clinics and hospitals (Italy, China, Uzbekistan) · Overall | RR 0.29 [0.20, 0.42] GRADE not reported Downgraded: risk of bias, imprecision, indirectness 3 studies |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Cassetta 2017 The influence of mandibular third molar germectomy on the treatment time of impacted mandibular second molars using brass wire: a… PMID:28408148 | 2017 | this review only | not stated | not extracted yet |
| Chiapasco 1995 Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications. PMID:7699496 | 1995 | this review only | Inferior alveolar nerve (IAN) injury; Overall postoperative complications (composite) | not extracted yet |
| Chossegros 2002 Is lingual nerve protection necessary for lower third molar germectomy? A prospective study of 300 procedures. PMID:12521318 | 2002 | this review only | not stated | not extracted yet |
| D'Angeli 2021 The Evaluation of Further Complications after the Extraction of the Third Molar Germ: A Pilot Study in Paediatric Dentistry. PMID:33504054 | 2021 | this review only | not stated | not extracted yet |
| Ludovichetti 2023 Marginal and Para-Marginal Technique in Late Germectomy of Lower Third Molars. PMID:37371308 | 2023 | this review only | not stated | not extracted yet |
| Mazur 2025 Factors affecting pain experience after lower third molar germectomy in teenagers-a clinical study. PMID:39674861 | 2025 | this review only | not stated | not extracted yet |
| Monaco 2017 Delayed onset infections after lower third molar germectomy could be related to the space distal to the second molar. PMID:27746008 | 2017 | this review only | not stated | not extracted yet |
| Sivolella 2011 Osteotomy for lower third molar germectomy: randomized prospective crossover clinical study comparing piezosurgery and conventional… PMID:21419542 | 2011 | this review only | not stated | not extracted yet |
| Yunusov 2025 CONSIDERATIONS FOR PROPHYLACTIC ORTHODONTIC GERMECTOMY TO PREVENT COMPLICATIONS FROM RETAINED THIRD MOLARS DOI:10.25005/2074-0581-2025-27-3-672-682 | 2025 | this review only | Overall postoperative complications (composite) | not extracted yet |
| Zhang 2012 Early extraction: a silver bullet to avoid nerve injury in lower third molar removal? PMID:22608199 | 2012 | this review only | Inferior alveolar nerve (IAN) injury; Overall postoperative complications (composite) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with developing mandibular third molars (tooth germ or early root formation) undergoing germectomy | Pediatric and adolescent patients (10 studies) |
| Intervention | Mandibular third molar germectomy (early removal, root formation up to one third, Nolla stage 7 or less) | Germectomy or early removal (n=10 studies) |
| Comparison | Delayed extraction at a more advanced root stage or older age; watchful waiting | Delayed extraction (3 studies in meta-analysis) |
| Outcomes | Primary: IAN injury, overall postoperative complications; secondary: postoperative morbidity (pain, swelling, trismus) and PROMs | IAN injury (2 studies pooled); overall postoperative complications (3 studies pooled); pain and PROMs narrative |
| Study designs | RCTs and comparative observational studies (single-arm studies in qualitative synthesis only) | 2 RCTs, 3 retrospective and 5 prospective observational studies; 3 comparative cohorts pooled |
| Timing | Not specified | Follow-up from 7 days to 24 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: No | NRSI: No · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |